[Neurometabolic therapy of mild cognitive impairment in patients with chronic cerebral ischemia]. / Neirometabolicheskaya terapiya umerennykh kognitivnykh rasstroistv u patsientov s khronicheskoi ishemiei golovnogo mozga.

OBJECTIVE: To evaluate the effect of a sequential therapy regimen with Mexidol (500 mg injections intravenously for 14 days) and Mexidol FORTE 250 (250 mg tablets 3 times a day for 60 days) on higher cortical functions in patients with moderate cognitive disorders in chronic cerebral ischemia. MATERIAL AND METHODS: A comparative, prospective study included 63 patients with chronic cerebral ischemia with moderate cognitive impairment. All patients received basic therapy aimed at reducing risk factors (antihypertensive, antithrombotic drugs as indicated). Patients of the main group (30 people: 12 men, 18 women) received Mexidol intravenously 500 mg in 100 ml of 0.9% NaCl solution once a day for 14 days, then Mexidol FORTE 250 (film-coated tablets) 250 mg 3 times a day for the next 60 days. The comparison group consisted of 33 patients (14 men, 19 women) who received only basic therapy. The groups were comparable in terms of age, sex characteristics and severity of cognitive deficit. We examined cognitive status (MoCA scale, Frontal Dysfunction Battery, 10 Word Memorization tests), severity of asthenia (MFI-20 scale), anxiety and depression (HADS scale), patient's subjective assessment of the dynamics of the condition (CGI-improvement scale) in 1st, 14th and 74th±5 days of observation. On days 1 and 74±5 of observation, patients were examined using transcranial magnetic stimulation to study the neuronal activity of the cerebral cortex. RESULTS: In the main group, at the time of completion of taking Mexidol and Mexidol FORTE 250, a pronounced cognitive regression was noted (MoCA scale +3 points, difference with the comparison group 1 point (p<0.0001); Frontal Dysfunction Battery test +4 points, difference with comparison group 2 points (p<0.001); memory test «10 words¼ +2 points, difference with the comparison group 1 point (p<0.05), emotional (HADS anxiety scale -8 points, difference with the comparison group 3 points (p<0.001), depression -3.5 points, difference with the comparison group 1.5 points (p<0.01), asthenic disorders (MFI-20 scale -30 points, difference with the comparison group 15.5 points (p<0.01), improvement in the well-being of patients (CGI-improvement scale -2 points, difference with the comparison group 1 point (p<0.0001). According to the transcranial magnetic stimulation performed, a statistically significant decrease in the central motor conduction time at the level of 1 and 2 motor neurons of the pyramidal tract bilaterally from the start to the end of therapy with Mexidol and Mexidol FORTE 250 was determined (p<0.01). An inverse correlation was found between the time of central motor conduction and the results of the Frontal Dysfunction Battery test at the same time points with left-sided localization of 1 motor neuron (p<0.01). The results of a study of the use of sequential therapy with Mexidol 500 mg IV drip 1 time per day for 14 days followed by oral administration of Mexidol FORTE 250 1 tablet 3 times a day for 60 days indicate its clinical effectiveness and safety in patients with chronic cerebral ischemia with mild cognitive impairment, and also confirm its importance for preventing the progression of cognitive disorders.

[Clinical phenotypes of optic nerve damage in patients with neuromyelitis optica spectrum disorder]. / Klinicheskie fenotipy porazheniya zritel'nogo nerva u patsientov s zabolevaniyami spektra opticheskogo neiromielita.

Neuromyelitis optica spectrum disorders (NMOSD) comprise a group of autoimmune inflammatory demyelinating diseases of the central nervous system that manifest as optic neuritis and transverse myelitis. Its manifestation in the form of optic neuritis makes early diagnosis difficult because neuroimaging of the spinal cord is not a part of the routine examination algorithm for such patients. This article presents the results of a comprehensive ophthalmological examination of 4 patients (8 eyes) diagnosed with NMSOD. Optic neuritis was the disease debut in 3 patients and had 1-2 relapses, in all cases partial optic atrophy with moderate to severe loss of visual function occurred. The clinical picture was characterized by a pronounced heterogeneity in terms of both ophthalmological symptoms, and accession of neurological disorders. Treatment of NMOSD requires differential diagnosis with multiple sclerosis, which depends on the awareness of specialists and the inclusion of antibody titers to aquaporin-4 and myelin oligodendrocyte glycoprotein into the examination algorithm of patients with optical neuritis.

[Treatment of attention deficit hyperactivity disorder in children: results of a multicenter, randomized, double-blind, placebo-controlled clinical trial]. / Terapiya sindroma defitsita vnimaniya s giperaktivnost'yu u detei: rezul'taty mnogotsentrovogo randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya.

OBJECTIVE: Evaluation of the efficacy and safety of the new drug Prospekta in the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 7-12 years. MATERIAL AND METHODS: A multicenter (35 clinical centres) double-blind, placebo-controlled, randomized, parallel-group clinical trial enrolled 363 patients. The mean age was 9.3±1.7 years. Children of both sexes aged between 7 and 12 years with a diagnosis of ADHD confirmed by DSM-V diagnostic criteria were included in the study. Patients with a total score of 22 or more on the Attention Deficit Hyperactivity Disorder-Rating Scale-V (ADHD-RS-V) were included in the study. After randomisation, patients in group 1 received Prospekta, 1 tablet twice daily; patients in group 2 received placebo according to the study drug regimen. The primary efficacy criterion was the proportion of patients with a 25% or greater reduction in the overall ADHD-RS-V scale score after 8 weeks of treatment. As additional criteria for efficacy assessment were assessed: change of ADHD-RS-V total score from baseline after 8 weeks of treatment; Clinical Global Impression Efficacy Index (CGI-EI) score after 8 weeks of treatment; side effects. RESULTS: The proportion of patients with a 25% or more reduction in the ADHD-RS-V scale score after 8 weeks of treatment was 55.9% in the Prospekta group, and 43.3% in the placebo group (p=0.0199). There was a reduction of ADHD symptoms in the Prospekta group as a mean ADHD-RS-V score decreased by 10.2±7.7 (in the placebo group by 8.1±7.9); the difference between the mean ADHD-RS-V score reduction during Prospekta and placebo treatment was 2.09±7.81 (p=0.0096). Mean CGI-EI scores calculated on the basis of physician scores were different in the Prospekta group compared to the placebo group at 6.9±3.2 versus 8.0±3.1 (p=0.0012), indicating greater clinical efficacy of the study drug. The frequency of adverse events (AEs) did not differ significantly between the groups. There were a total of 66 AEs in 46 patients, including 31 AEs in 23 (13.2%) Prospekta group participants and 35 AEs in 23 (12.2%) placebo group participants (p=0.87). No cases of serious AEs were reported during the study. Prospekta is compatible with drugs used in pediatric practice. Prospekta did not cause an exciting effect and did not adversely affect the sleep of patients. CONCLUSION: The drug Prospekta is an effective and safe treatment for ADHD in patients 7-12 years old.

[Therapy of moderate cognitive impairment and asthenia in patients with cerebrovascular pathology: results of a prospective observational study]. / Terapiya umerennykh kognitivnykh narushenii i astenii u patsientov s tserebrovaskulyarnoi patologiei: rezul'taty mnogotsentrovoi otkrytoi prospektivnoi nablyudatel'noi programmy.

OBJECTIVE: Obtaining additional data on the efficacy and safety of the drug Prospekta in the treatment of moderate cognitive impairment (MCI) and asthenia in patients with cerebrovascular disease (CVD). MATERIAL AND METHODS: A prospective observational study in more than 40 Russian cities enrolled 232 patients (mean age 61.5±10.0 years) with mild cognitive impairment (MCI), asthenia on ongoing basic nootropic therapy. The presence of MCI was confirmed by the Montreal Cognitive Assessment Scale (MoCA), asthenia - by 10-point Visual Analog Scale (VAS). All patients were prescribed the nootropic medication Prospekta 2 tablets 2 times a day for 8 weeks in addition to the therapy they received. Ultrasound Doppler sonography of the main arteries of the head and magnetic resonance imaging (MRI) of the brain were also assessed. At the end of treatment, the Clinical Global Impression Efficacy Index (CGI-EI) was assessed and the safety of the treatment was evaluated. RESULTS: The baseline severity of cognitive impairment according to the MoCA scale was 21.6 points, severity of asthenia according to the VAS was 6.3 points. According to Doppler flowmetry findings, hemodynamically significant stenosis was revealed in 105 (49.3%) patients, and narrowing of the main vessels without changes in hemodynamic parameters was revealed in 108 (50.7%) patients. According to MRI results, single vascular lesions in the brain matter were detected in 102 (44.0%) patients. The medications with nootropic effect were administered to 144 (62.1%) patients. A positive therapeutic response as improvement of cognitive functions was seen in 93.3% of patients after 8 weeks of taking Prospekta, including 39.4% of patients who had cognitive functions restored to the normal level. No side effects were registered during the observational study. CONCLUSIONS: The nootropic medication Prospekta is effective and safe in treatment of MCI in patients with asthenia with CVD, and improves cognitive function in patients with asthenia with CVD, both in monotherapy and in combination with other nootropic agents.

[Update on the etiology and pathogenesis of muscle dystonia]. / Sovremennye predstavleniya ob etiologii i patogeneze myshechnykh distonii.

Muscle dystonia is one of the most common extrapyramidal diseases and is the third most common after essential tremor and Parkinson's disease. The introduction of diagnostic methods expanded the understanding of the genetic basis of muscle dystonia and neurophysiological mechanisms of dystonic phenomena. However, the questions of the etiology and pathogenesis of dystonia still remain the subject of close interest of researchers. The review provides up-to-date information about the etiology and pathogenesis of muscle dystonia. Recent changes in the genetic nomenclature of dystonia are described. Modern ideas about the pathogenetic significance of such mechanisms as abnormalities of neural inhibition, disturbances of sensorimotor integration, and abnormalities of neural plasticity are considered. Recent research data support the concept of systemic sensorimotor disintegration, including not only basal ganglia dysfunction, but also motor network disorders involving the cerebellum, cortex, midbrain, thalamus and other areas.

[The dynamics of erythrocytes functional indicators in patients with Charcot-Marie-Toota disease during cytoprotective therapy]. / Dinamika funktsional'nykh pokazatelei éritrotsitov u patsientov s bolezn'iu Sharko-Mari-Tuta pri primenenii tsitoprotektivnoi terapii.

AIM: To study an impact of cytoflavin on the functional state of erythrocytes in patients with Charcot - Marie - Toota disease (CMTD). MATERIAL AND METHODS: Thirty patients with CMTD were examined. The main group (n=17) received cytoflavin along with basic therapy (intravenously dropwise 10 ml per 200 ml of 5% glucose solution for 10 days). The comparison group (n=13) received only basic therapy. Functional parameters of erythrocytes, including electrophoretic mobility of erythrocytes (EFME), concentration of malonic dialdehyde (MDA), content of ATP and 2.3-DPG in erythrocytes, were evaluated. The level of physiological norm of the studied parameters was determined in 20 healthy people (the control group). To assess clinical symptoms, the MFI-20 scale and a 20 meter walking distance were used. RESULTS AND CONCLUSION: There was a decrease in EFME and concentrations of ATP, 2.3 DFG and an increase in MDA concentration in the main group compared to the control group. After treatment with cytoflavin, there was an increase in the content of ATP, 2.3 DFG and EFME and a decrease in the concentration of MDA. The similar but less pronounced changes were observed in the comparison group. At the same time, the content of 2,3 DPG and the concentration of MDA did not reach the level of the physiological norm. The changes in functional indicators of erythrocytes were associated with clinical indicators. A significant decrease in the severity of asthenia according to the MFI-20 scale, an increase in walking speed, a decrease in the average walking time by 20 seconds (by 5 seconds in the comparison group) were observed in the main group. The results make it possible to classify the use of cytoflavin in CMTD as a method of pathogenetic therapy.

[Therapy of asthenoneurotic syndrome in patients with focal muscular dystonia]. / Terapiia astenonevroticheskogo sindroma u patsientov s fokal'nymi myshechnymi distoniiami.

AIM: To analyze the prevalence and structure of asthenoneurotic disorders in patients with focal muscular dystonia and determine an effect of the anxiolytic аdaptol (tetramethyltetraazabicyclooctandion) on asthenic syndrome in muscular dystonia. MATERIAL AND METHODS: Forty patients with focal muscular dystonia were examined. The severity of asthenic syndrome (MFI-20), anxiety (the Hospital scale of anxiety and depression) and depression (the Hamilton Depression Rating Scale) were evaluated. RESULTS AND CONCLUSION: Asthenic syndrome and anxiety disorder are independent non-motor manifestations of focal muscular dystonia. Adaptol has a positive effect, significantly reducing anxiety and asthenia in patients with focal muscular dystonia.

[The system stress-limiting action of mexidol in chronic cerebral ischemia].

OBJECTIVE: To clarify the mechanisms of the action of anti-stress antioxidant agent (mexidol) in patients with chronic cerebral ischemia. MATERIAL AND METHODS: Sixty-seven patients with chronic cerebral ischemia (TE stage II),48 women and 19 men, mean age 48.2 years, were examined. To assess the stateof multilevel stress system, the level of anxiety and depression, degree of autonomic imbalance, adaptive reactions of the blood and functional properties of erythrocyte membranes, level of average weight molecules in the blood plasma were studied. Therapeutic complexes consisted of standard therapy (vinpocetine and piracetam) and mexidol (10 ml intravenous drip 200 ml of physiological solution once a day every day for 10 days with subsequent transition to the oral ingestion of the drug (1 tablet (125 mg) 3 times a day for three months). RESULTS AND CONCLUSION: In group 1 treated with additional antioxidant mexidol, the more pronounced and prolonged positive effect on the clinical symptoms of TE was observed. There were the persistent decrease in the level of anxiety and reduction of autonomic imbalancein the main group. The dynamics of adaptive reactions of blood indicated the activation of the adrenal cortex. There was a decrease in the content of average weight molecules and recovery of the sorption capacity of red blood cells. The results indicate the multi-component multi-level stress-limiting effect of mexidol in patients with chronic cerebral ischemia stage II.

[STRESS-PROTECTIVE EFFECT OF CYTOFLAVIN ON CHRONIC CEREBRAL ISCHEMIA IN RATS.]

Analysis of stress-releasing blood reactions (electrophoretic mobility of red blood cells, WBC count, and leukocyte ratio) in rats with experimental cerebral ischernia under the action of cytoflavin held showed that cytoflavin in combination with basic therapy leads to further activation of compensatory-adaptive reactions of the body and stimulated peripheral stress-limiting mechanisms.

[An effect of cytoprotective therapy on stress resistance and compensatory abilities of patients with chronic cerebral ischemia].

OBJECTIVE: To study an effect of nonspecific cytoprotective therapy on clinical manifestations, disease course and indicators of stress system in patients with different stages of chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Authors examined 266 patients with CCI, aged from 35 to 55 years. The patients received basic and nonspecific cytoprotective therapy. The dynamics of subjective and objective symptoms of encephalopathy, clinical outcomes after a year of observation, and the state of stress system were analyzed. An effect of therapy on stress was assessed by the dynamics of blood pressure reactions to stress. RESULTS AND CONCLUSION: An open randomized comparative study has shown that the inclusion of the drug with nonspecific cytoprotective actions (cytoflavin) in the therapeutic complex improves the therapeutic effect on the clinical manifestations of CCI. The higher frequency of favorable outcomes over one year of follow-up is associated with the optimization of stress system activity under nonspecific cytoprotective therapy and the increase in stress resistance.

[Adaptogenic effects of mexidol in chronic cerebral ischemia].

The data on the effect of the succinate-containing antioxidant mexidol on the adaptation abilities of patients with chronic brain ischemia are presented. We studied 98 patients with discirculatory encephalopathy of I, II and III stages. A set of indices for psychoemotional status, functional state of the brain, autonomic status, nonspecific stability to hypoxia, adaptive reactions of the blood system and status of antioxidant defense have been used to evaluate adaptive abilities of the body. It has been shown that the introduction of the antioxidant in the treatment set strengthens the effects of basic treatment by increasing adaptive reserves of the body in stages I and II of disease that is related with the realization of reactions of urgent adaptation. The introduction of mexidol in the treatment set increases the frequency of favorable outcomes after one year of follow-up.

[The diagnostics of adaptive reactions of blood on application the stress-modulating therapy in patients with brain chronic ischemia].

The article deals with the results of analysis of electrophoretic mobility of erythrocytes and leukogram in patients with dyscirculatory encephalopathy on different stages of disease on application therapy with inclusion of stress-modulating pharmaceuticals into course of treatment. It is established that the electrophoretic mobiliy of erythrocytes makes it possible to evaluate the adaptive indicators blood in patients with dyscirculatory encephalopathy. The consideration of these indicators makes feasible the substantiation of inclusion of stress-modulating therapy into complex treatment of patients with chronic cerebrovascular inefficiency.

[Possibilities of preventive treatment of Alzheimer's disease: results of the 3-year open prospective comparative study on efficacy and safety of the course therapy with cerebrolysin and cavinton in elderly patients with the syndrome of mild cognitive impairment].

The study was conducted in 3 Russian centers (Moscow, St. Petersburg and Nizhniy Novgorod). The total sample included 110 patients whose mental state met the definition of <> (MCI). Patient's status was assessed with widely used scales (MMSE, GDS, CDR etc) and a battery of neuropsychological tests. Genotyping for the APOE polymorphism was performed as well. Patients were stratified into 2 comparable groups in compliance with the specifics of therapy: 55 patients were treated with cerebrolysin and 55 - with cavinton. The superiority of cerebrolysin over cavinton in slowing down of the cognitive deficit progression and delaying the time or transition of patients to the diagnostic category of Alzheimer's disease was demonstrated. Cerebrolysin was particularly effective in MCI patients with the ApoE(+) genotype, i.e. in those with higher risk for Alzheimer's disease. Adverse effects during the treatment were rare in both groups.

[Nonspecific adaptive reactions blood in chronic brain ischemia].

Clinical and experimental studies were under way to examine nonspecific adaptive reactions of blood in chronic brain ischemia. The electrophoretic mobility of red blood cells and differential blood count were studied in animals (rats) when simulating local and total brain ischemia, as well as in patients with stages I, II, and III dyscirculatory encephalopathy. General mechanisms responsible for changing the adaptive reactions of blood were found in varying chronic brain ischemia in the experiments and clinical observations. These characterize the activity of the pituitary-adrenal system and the state of an adaptive process in the body.

[Typical changes in the electrophoretic mobility of red blood cells and their phospholipid composition in different diseases].

Changes in the electrophoretic mobility of red blood cells and their phospholipid composition were studied in patients with psoriasis and duodenal peptic ulcer. A relationship of the electrophoretic mobility of red blood cells to their phospholipids spectrum was established in the above diseases. The paper shows the same change in the electrophoretic mobility of red blood cells and a change in the fractions of phosphotidylethanolamine, sphingomyelin, lysophosphotidylcholine of the erythrocytic membranes.